Finasteride for Hair Loss
Medically reviewed by Leann Poston, M.D. on 9/17/20
What’s the best hair loss treatment for men? Talk to anyone that is currently or has already lost some hair, and they will tell you it feels like you are fighting a losing battle. Androgenic alopecia, more commonly referred to as male pattern baldness, affects an estimated 50 million men and 30 million women in the United States and can be extremely detrimental to these individual’s self-image and self-confidence (Genetics Home Reference, n.d.).
Many products claim to work, but in reality, nothing you can get from a supermarket aisle, over the counter, or online without a prescription is going to make much of a difference at all. Short of hair transplant surgery, which is financially impractical for most people, there just aren’t many truly effective treatments to restore hair and prevent further loss.
Fortunately, a prescription medication has been clinically proven to help stop hair loss and even has the potential for stimulating hair regrowth. That medication is a compound called finasteride. As it often goes, finasteride’s ability to potentiate hair regrowth in men (and women to a lesser extent) suffering from androgenic alopecia was discovered purely out of happenstance.
Finasteride: Early History
Interest in developing a drug able to negate the effects of DHT on hair follicles (dihydrotestosterone, more on this hormone and its link to hair loss later), go all the way back to the 1970s. However, it wasn’t until 1992 that finasteride was approved for the treatment and prevention of a condition called benign prostate hyperplasia (BPH, or simply an enlarged prostate). BPH can be caused by the same hormone (DHT) and similar mechanisms that lead to hair loss.
Fast forward half a decade to 1997, when the FDA approved finasteride for the treatment and prevention of male pattern baldness; slow beginnings for a medication that was prescribed to over 10 million people in 2016. But how does it work exactly? That is what is most interesting about finasteride as a compound, its mechanism of action.
The androgenic hormones
There are two relevant androgenic hormones in the male: testosterone and its derivative dihydrotestosterone. These hormones have the following effects:
- In utero: Wolffian duct derivatives (seminal vesicles, vas deferens, epididymis, ejaculatory ducts)
- After puberty: muscle mass, deepening voice, libido, growth of external genitalia, sperm production (Marks, 2004)
- In utero: development of the male external genitalia
- After puberty: facial acne and beard, male pattern baldness, prostate growth (Marks, 2004)
5α-reductase is an enzyme (a protein in the body that speeds up a chemical reaction) with two forms, type I and type II. Type I 5α-reductase is more prevalent in the liver, nongenital skin, scalp, sebaceous gland, brain, ovary, prostate, and testes. Type II 5α-reductase is more prevalent in the prostate gland, epididymis, seminal vesicle, uterus, genital skin, breast, hair follicle, and testis. 5α-reductase catalyzes the conversion of testosterone to DHT. About ten percent of testosterone in all adults is converted to DHT. Scientists believed that drugs could be developed to shrink the prostate and relieve male-pattern baldness and androgen triggered acne by targeting 5α-reductase after the external genitalia were fully formed and mature (Marks, 2004). Finasteride is one of those drugs.
Finasteride: Mechanism of Action
Finasteride is a competitive inhibitor of Type II 5α-reductase. This means it inhibits the enzyme Type II 5α-reductase and decreases its ability to convert testosterone to DHT. By blocking Type II 5α-reductase, the conversion of testosterone to DHT is reduced by up to two-thirds (Gormley et al., 1990). Clinical trials testing Finasteride were started in the 1980s and completed in 1992. The drug had demonstrated both safety and efficacy (Marks, 2004).
Finasteride reduces the amount of circulating DHT in the body and slightly increases the level of testosterone. Finasteride does not affect other hormone levels, such as luteinizing hormone and follicle-stimulating hormone. This finding shows that finasteride does not change the regulation of testosterone production (McClellan & Markham, 1999).
In those who are genetically predetermined, DHT shortens the growth phase of the hair from years to weeks or months and decrease the size of the hair follicle. Your susceptibility for male-pattern baldness was passed on genetically and is likely due to your specific DHT receptor density in different regions of the body (thanks Mom and Dad). Have a lot of DHT receptors on your scalp? Hair loss is likely in the cards. Family history of prostate issues? You likely have more than the average amount of DHT receptors there. While it’s not quite that simple, and many other factors come into play, understanding this individuality is key to realizing why some people lose hair, and others don’t.
Does Finasteride Really Work?
Treatment and prevention of hair loss are among those markets that seem to be full of shady companies selling snake oil on late-night television. They show you before and after pictures, playing on your emotions to get you to purchase their products that you hope will bring back that mane you had in high school. Although those products were never going to work, the good news is that finasteride has the research and results to back up its claims.
For instance, in 1999, it was concluded that “finasteride is generally well tolerated and leads to improvements in hair growth in men with [androgenetic alopecia], and slows the further progression of hair loss that occurs without treatment.” More specifically, no further hair loss was observed in 83% of men treated with finasteride after two years, and 61% saw regrowth (Kaufman et al., 1998).
As always, the degree to which individuals respond to a medication of any kind is highly variable, but these numbers are significant. In fact, studies have been conducted for up to 5 years, proving a net increase in scalp hair count with finasteride use (Finasteride Male Pattern, 2002). Overall, finasteride provides an effective mechanism to battle and reverse hair loss due to androgenetic alopecia. This likely makes it one of the best hair loss treatments for men. It may be tempting to buy finasteride online but use extreme caution. Although it targets the root cause of hair loss with precision, finasteride isn’t without potential side effects.
Potential Downsides of Finasteride Use
When compared to most prescription compounds, finasteride has relatively minimal side effects. That being said, because it is used primarily for cosmetic purposes, its side effects likely deserve to be examined a bit more closely than those of life-saving medications. Here are a few of the concerns regarding using finasteride, but keep in mind you will need to consult with a medical professional to get the full picture. In three clinical trials of 12 months, only 1.4% of patients taking Propecia (brand name of finasteride) had to drop out due to adverse experiences (Propecia, 2018).
Take into consideration that clinical trials and anecdotal evidence can and often will say two different things. From people in the real world utilizing finasteride, sexual dysfunction is the most common complaint including decreased libido, erectile dysfunction, and ejaculatory disorder. This dysfunction is likely due to its ability to block the conversion of testosterone to DHT, but if you look at the lab results of those taking finasteride, there aren’t many indicators of why this might be occurring.
Let’s talk specifics for a second. When taken, finasteride reduces serum levels of DHT within 24 hours. However, it doesn’t bind to androgen receptors. It has been shown to not meaningfully change luteinizing hormone levels (the initial signal that comes from the pituitary gland telling your testes to produce testosterone). Similarly, it did not affect the levels of cortisol, thyroid-stimulating hormone, thyroxine, plasma lipids, or bone mineral density (Propecia, 2018). Overall, it has little or no impact on hormones other than dihydrotesterone, which, as you know, is the reason for taking it in the first place.
In the end, you must weigh the pros and cons of utilizing any medication. Taking steps to mitigate potential side effects, such as adhering to a generally healthy lifestyle, should always be part of a successful treatment plan. Speaking with a medical professional will help you decide if the benefits of using finasteride outweigh the potential downfalls. The question is: How much does preventing hair loss or facilitating the regrowth hair already lost matter to you?
Where Can You Get Finasteride?
Finasteride may be the best hair loss treatment for men but use requires a prescription from a medical professional. To buy finasteride online overseas without a prescription is a risky gamble, and with the accessibility of medical professionals now it is one that simply isn’t worth taking.
There are businesses that conveniently provide you access to medical advice and prescription from a licensed professional. Telehealth is a newer industry that offers the convenience of medical consultations without the need to visit the doctor’s office. Patients can get a prescription from the convenience of their own home or office. Physicians can send the patient’s prescription directly to the pharmacy who can mail it directly to the patient’s home. Truly the only safe way to buy finasteride online. If you are looking for help in the fight against hair loss you don’t have many allies, but finasteride may be just what you need to start fighting back today.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
- Genetics Home Reference, National Library of Medicine. (2020) Androgenetic alopecia. https://ghr.nlm.nih.gov/condition/androgenetic-alopecia#statistics
- Gormley GJ, Stoner E, Rittmaster RS, et al. (1990). Effects of finasteride (MK-906), a 5α-reductase inhibitor, on circulating androgens in male volunteers. J Clin Endocrinol Metab;70:1136-1141
- McClellan, K.J., Markham, A. (1999). Finasteride. Drugs 57, 111–126. https://doi.org/10.2165/00003495-199957010-00014
- Marks L. S. (2004). 5alpha-reductase: history and clinical importance. Reviews in urology, 6 Suppl 9(Suppl 9), S11–S21.
- K.D. Kaufman, E.A. Olsen, D. Whiting, et al. (1998). “Finasteride in the treatment of men with androgenetic alopecia”. J Am Acad Dermatol, 39, pp. 578-589
- Finasteride Male Pattern Hair Loss Study Group Long-term (5-year) multinational experience with finasteride 1 mg in the treatment of men with androgenetic alopecia. (2002). J Eur Dermatol, 12, pp. 38-49
- Propecia. Buy Finasteride Online. RxList. (2018) https://www.rxlist.com/propecia-drug.htm#description